Healthcare Provider Details

I. General information

NPI: 1023078961
Provider Name (Legal Business Name): JILL SUZANNE DAVIDS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 E EXCHANGE ST
CRETE IL
60417-3454
US

IV. Provider business mailing address

1080 E EXCHANGE ST
CRETE IL
60417-3454
US

V. Phone/Fax

Practice location:
  • Phone: 708-672-3937
  • Fax: 708-672-3940
Mailing address:
  • Phone: 708-672-3937
  • Fax: 708-672-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: